Healthcare Provider Details

I. General information

NPI: 1285260729
Provider Name (Legal Business Name): BEVERLY CRUMP PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 SINCLAIR RD STE 215
COLUMBUS OH
43229-5434
US

IV. Provider business mailing address

3099 SULLIVANT AVE STE H
COLUMBUS OH
43204-1800
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2303
  • Fax: 800-905-9950
Mailing address:
  • Phone: 614-371-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: